Coronary Calcium Best Predictor Of Heart Health

Cholesterol level and high coronary calcium indicate risk of heart attack

(RxWiki News) Doctors are always looking for new ways to predict heart attacks and strokes -- especially among patients with normal cholesterol levels who may not appear to be at risk.

The presence of calcium in coronary arteries may be a better predictor of heart attacks or strokes than C-reactive protein, an indicator of inflammation somewhere in the body, among patients with normal "bad" LDL cholesterol levels.

"Ask your cardiologist if you would benefit from statins."

Dr. Michael J. Blaha, lead researcher, and a cardiology fellow at the Johns Hopkins University School of Medicine and the Johns Hopkins Heart and Vascular Institute, explained that the study was a direct comparison between patients with a normal LDL of less than 130 mg/dL. The finding could help doctors decide which higher risk patients with normal cholesterol might benefit from taking statins, generally used to lower cholesterol, but beneficial to other heart patients as well.

Researchers followed more than 2,000 patients for six years to determine which group was at a higher risk. Participants had participated in the Multi-Ethnic Study on Atherosclerosis, known as MESA, funded by the National Institutes of Health.

Evidence of coronary calcium was measured through a cardiac CT imaging test while C-reactive protein was measured through a blood test.

Dr. Blaha and his research team found that 95 percent of heart attacks, strokes or heart-related deaths in the study population occurred in patients with measurable calcium in their heart arteries.  About 13 percent of individuals with the highest levels of coronary calcium had a heart attack or stroke during the study period.

Only 2 percent that had high C-reactive protein but no calcium buildup had a heart attack or stroke. This led researchers to conclude that high levels of C-reactive protein had little value in helping to predict heart attacks or strokes even after accounting for other risk factors such as family history.

This research was a follow up to a 2008 study called JUPITER, or Justification for the Use of Statins in Primary Prevention: An Interventional Tool Evaluating Rosuvastatin. That study found a 46 percent reduction in heart attacks among individuals with normal LDL cholesterol and a high level of C-reactive protein who took statin medication rosuvastatin. Coronary calcium testing was not included in that study.

Dr. Blaha said while not all patients need a calcium scoring test, it makes sense in certain patients to predict which may benefit from statin therapy. The calcium scoring test is most appropriate for those with an intermediate risk of a heart attack over the next 10 years. This includes patients who seem in good health, but have a family history of heart disease or may smoke or be overweight.

The research was published in The Lancet.

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Review Date: 
August 24, 2011